I CINAPSE – I International Conference of Physical Activity and Health Promotion at School

Motricidade

2017, vol. 13, n. S1, pp. 1-6 I CINAPSE 2016

1 _{State University of Ceará, Fortaleza, Brazil.}

2 _{Avantis College, Balneário, Camboriú, Brazil.}

* Corresponding author: State University of Ceará, Dr. Silas Munguba Av., 1700, Campus do Itaperi, 60714-903,

Fortaleza-CE, Brazil. Email: ricardo.catunda@uece.br

Recommendation Letter of CINAPSE 2016

Ricardo Catunda

_{, Elisabete Laurindo}

EDITORIAL

In order not only to promote the debate on physical activity and health promotion at school but also to think of qualified joint actions about the problems related to the subject, the Center for Research on Physical Activity in School (NIAFE) held CINAPSE - the International Conference of Physical Activity and Health Promotion at School: "Building a healthy environment", through a partnership among renowned institutions, such as the State University of Ceará; the Federal Council of Physical Education - CONFEF; the Regional Council of Physical Education of Ceará - CREF5 / CE; the Association of the State of Ceará Municipalities - APRECE, and the Sports Virtual Center - CEV, as well as professionals from three countries: Brazil, Spain and Portugal, with representatives from 15 states and 8 researchers groups, where everyone was engaged in fostering discussions about physical activity in the school environment in the perspective of health promotion, involving national and international references and the Brazilian academic community in the debate through Panels, Conferences, Presentation and publication of scientific works, courses, besides the integration of 15 study groups.

The opening panel wad focused on "Recommendations of public institutions about health promotion at school", with the speaker Mr. Jorge Steinhilber, president of CONFEF, who highlighted the importance of the involvement of parliamentarians’ involvement, particularly regarded as the demand of the implementation of laws and documents already drawn up by expertise people involved in it. On this field, it should be reflected and analysed how all knowledge

acquired is being applied, mainly by physical education teachers, who have an important role in people's lives, moving towards the health area.

With the breakthrough of the Profession Regulation, through Law no. 9696 1998, professionals in the field have sought to specialize and integrate with other knowledge areas, especially in inter-sectoral public policies, such as the bodily practices and promoting physical activity in the Family Health Support Center - NASF, the Health Gyms, the Health in School Program - PSE, the National School Meal Program - PNAE, among others.

We live in a globalized world, which problems related to social issues are portrayed by inactivity, increase of nutritional options - usually the inadequate ones -, the decrease of the population’s physical activity, the constraint of children’s movement with the use of new technologies growing up, combined with the increased rates of urban violence.

In face of this reality, there is an urgent need to reaffirm the importance of physical activity as an essential condition to a healthy lifestyle at all stages. However, it is at school where we can enhance an awareness movement with families about the importance of their participation, as a means of reinforce proactive actions to develop healthy habits. Therefore, IT IS RECOMMENDED THAT:

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a need to promote professional and qualified interventions in the school context, creating healthy and suitable environments to human needs;

✓ public policies can reflect the needs and desires of the people involved;

✓ Physical Education, as a curriculum component, ought to be valued as a health promoter in its broader aspects and, professionals with proper skills and knowledge should get involved as protagonists in the execution process of the objectives to be achieved;

✓ successful experiences, both in schools and in universities, can be disseminated and replicated in order to generate a common knowledge compilation; ✓ we must recognize that 80% of Brazilian

children are in public schools, and there is the only place where can provide knowledge about the importance of acquiring healthy habits to promote health throughout life;

✓ we must understand it is unquestionable to bridge the academic field of scientific research, seeking their effectiveness through the practical application of the results, promoting concrete interventions in the daily life of Brazilian schools;

✓ the profession of physical education, recognized and regulated by Law No. 9,696 / 1998, must be respected and valued in schools;

✓ besides physical education classes, it is important and necessary to promote sports activities after their regular schedule, in order to minimize the condition effects of health problems throughout life;

✓ it is necessary to optimize children’s free time and promote human values and healthy habits;

✓ governments must maintain schools in appropriate and safe conditions.

At the Conference I: "Health promotion: the new trustworthy paradigm of School Physical Education", given by professor Dr. Adilson

Marques, University of Lisboa / FMH, Portugal, he pointed out the reasons for an area of expertise integrates the school curriculum and therefore is justified, this area needs to have a socially acceptable meaning, in other words, when it is important; when you have a body of specific knowledge. In this sense, the Physical Education in Brazil have been determined by some legitimizing systems throughout history. Initially these systems were considered only as gymnastics activities, later they were used to legitimate the superiority of the countries, to strengthen the body and race vigour, then to the health and nationalism, and also for the sport.

As it has been recorded in the 1950s, when physical activity and health were discussed about, recent studies again have showed the connection between them, pointing a considerable death rate as a consequence of a sedentary lifestyle. In this regard, today's social message sees a legitimizing factor of the physical education in physical activity, sport and exercise, which is more focused on health promotion, but with a condition that is under the teachers’ responsibility, the teaching - the way of teaching. It is a sine qua non that people have "physical literacy", ie, they need to learn to do - learn to want to do. One can also sees a significant increase in the number of and scientific studies publications on the subject, in one hand expanding knowledge, but on the other hand, the practice of physical activity suffering a downward trend throughout the world.

In this aspect, the main consensus indicates that regular physical activity benefits health. So, IT IS RECOMMENDED THAT:

✓ every person should be "physically educated" to maintain the health and quality of life;

✓ actions involving physical activity and various sports ought to be developed in schools and communities, in order to minimize the prevalence of obesity; ✓ the School Physical Education should be

legitimized as a proper area of expertise in Education;

Recommendation Letter of CINAPSE 2016| 3

✓ every effort must be invested in prevention: first address health and not disease.

At the Conference II: "Physical Education Evidence-based", given by professor Dr. José Airton Pontes Junior, the State University of Ceará, a reflection on some challenges of today as the use of new technologies in physical education classes; the inclusion of children with disabilities and; mainly on effectiveness level of lessons, questioning the poor results at the National High School Exam (ENEM), especially in the North and Northeast regions, which presented a low performance, compared to the other Brazilian regions.

In this sense, IT IS RECOMMENDED for Physical Education in school:

✓ the use of technology in everyday school life;

✓ teacher training with significant practice and the adequate evaluation tools; ✓ the condition of quantitative studies on

socio-cultural and educational variations in physical education students in teaching, management and the community dimensions;

✓ the mapping of reports of successful experiences and interventional research; ✓ to develop a "Cochrane" collaboration for

making evidence-based decisions through good quality information in the field of Physical Education;

✓ to maintain a permanent relationship between school and university, investing in professional masters’ degree and projects involving the community; ✓ to overcome the laziness and

comfortable situation the Brazilian education is placed nowadays;

✓ to increase the children’s level of stimulation for their full motor development;

✓ to include the curricular component "Health promotion" in the syllabus of undergraduate courses in Physical Education, teaching future teachers how to work in an interdisciplinary approach at school.

At the Conference III: "Physical Education: from research to intervention", done by Professor Dr. Nadia Cristina Valentini, the Federal University of Rio Grande do Sul, it was emphasized the need for understanding about the true role of physical education in school. We must recognize that there are differences in performance because there are no common goals, but there are difficulties in action which are common. It is therefore urgent to break paradigms and be aware that most of Brazilian children have opportunities of movement only at school and have motor delays with significant impacts, an alarming increase in the reduction of development of their basic motor skills.

Besides the children’s low motor competence, another fact to be highlighted is the decreasing proficiency movement in children who start school from the age of 6 years old, demonstrating that the possibility of movement have decreased, rather than increased. Other problems were also observed from the research, such as: the delay of motor skills in 18% of children in Brazil; the high level of impairment in the poorest children; the reduction of appropriate areas for activities which stimulate movement; the decline in physical fitness; the high rates of obesity, especially in the suburban and central urban areas; the fragility of the self-concept, that is, children see themselves as more incapable and; the important finding that children with motor difficulties also present cognitive difficulties.

Faced with the problems presented, it is evident that the qualified intervention of the Physical Education teacher is the main factor to transform this reality, also resulting in some questions elicited: How is the children’s cognitive development? How can children's skills be changed? What would stable and consistent solutions be? We must disturb the stability and break the lack of proficiency barrier. We must agree that the traditional P.E. classes do not promote proficiency, movement mastery and success in the correct execution of the

movement. Therefore, IT IS

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✓ class time should be optimized to provide children’s autonomy;

✓ the materials used in class should be diversified to enable the work in different stations;

✓ We must respect the own pace of each child;

✓ It is essential to vary the levels of challenges and skills of children;

✓ It is necessary to allow the exploration of the body by their own;

✓ to establish protocols between teachers and students;

✓ individual achievements must be valued; ✓ to promote parental involvement with

the school and their children’s lives; ✓ the self-monitoring of the child's

progress and the learners’ engagement in this process must be encouraged; ✓ children with special needs or other

disabilities must be included in classes and school activities;

✓ the awareness that 24 classes with a high quality can modify the children’s motor development and motor skills;

At the Conference IV: "Intervention programs for the development of physical activity and health promotion in school", performed by professor Dr. Valter Cordeiro Barbosa Filho, the Federal University of Santa Catarina / NuPAF, the concept of health, established by World health organization in 1946, was remembered, and the relationship between health and disease was already stablished at that time, saying that health is not merely the absence of disease but a state of complete physical well-being. Health is, above all, the normal state of human body's functioning, it's essentially living in good physical and mental disposition, besides the welfare among the individuals.

It is necessary to expand the look at this complex, which is the health care. One must understand there are social aspects which are decisive, like people’s working conditions, the commitment of our governments, and also the involvement of the whole community, schools, parents and teachers.

In this context, Physical Education has an important role because it teaches people to act for themselves and for the others, both by physical activity and the moments of discussion and reflection. Physical education must have a crucial role on the proposal of health promotion. We are properly prepared and cannot be limited only to the speech. Thus, IT IS RECOMMENDED THAT:

✓ physical activity and health programs should be developed in an intrapersonal perspective - attitude, self-efficacy, and interpersonal;

✓ topics on health should be included in the curricula of all levels of education; ✓ diversified materials should be offered

during the class breaks;

✓ to produce explanatory leaflets on health conditions;

✓ people involved in the subject should participate in the decision-making processes;

✓ to promote the approach between the school and the family context, with their different realities;

✓ to promote the teachers’ training for this new teaching perspective;

✓ to know the people with whom we are working, for the necessary school integration;

✓ to deconstruct our methodologies. We are used to getting things ready very fast, as if it was natural;

✓ to reflect on how our students are being taught. We need to stop saying what they have to do, we need to discuss the guidelines of how to increase the classes quality.

✓ it is necessary to leave the comfort zone and complex way of looking to reality in which we live to apply what we have learned, from the possibility of enjoyment, promotion of well-being, health, promotion of pleasure; the cultural construction of teachers and students;

Recommendation Letter of CINAPSE 2016| 5

different society, able to produce knowledge related to the practice of everyday school routine. The university needs to have "room" at the school; ✓ we need to identify what is our role in

public policy is.

At the Conference V: "Teaching Styles for School Physical Education: increasing levels of physical activity in the classroom", done by professor João Martins, the Faculty of Human Kinetics at the University of Lisbon and Lusófona University / FEFD of Portugal says that physical activity is a public health priority and the school is a privileged and recognized agent to promote this practice, whether in active recreation, in school sports in the physical education classes and the community where they live. He corroborated the idea that the physical education teacher is the agent protagonist of these activities.

Updated data have shown that most people do not meet the minimum and necessary time of moderate to vigorous physical activity a day, either in physical education classes. The great challenge in our area is to make the classes more active and methodologically appropriate. Therefore, IT IS RECOMMENDED:

✓ to promote the increase of physical activity in the classroom, so that people have pleasure in exercise throughout his life, in leisure time, in health clubs, squares, etc;

✓ the need to change the characteristics of the classes, promoting activities in which everyone has opportunities to participate;

✓ motivate children and young people to become physically literate – they know to dance, play, make your walk, etc; ✓ what goals are set to be followed and

awareness of the need for planning lessons, articulated with the whole school;

✓ time away from classes is optimized by reducing the time for instructions, in addition to the systematization of the routines;

✓ the available materials and spaces the school has should be maximized;

✓ to promote the inclusion of everyone; ✓ to make challenging classes, effectively

in the instructions, minimizing errors and enhancing the leadership and autonomy of students to promote meaningful knowledge for life and lifelong;

✓ to give positive feedback, with individual orientations, in a favourable mood for mastery;

✓ to use a variety of cooperative activities by promoting a vast teaching repertoire; ✓ to organize the class into smaller groups

to facilitate and streamline the intervention classes;

✓ to observe students’ affective, motor, cognitive, social and behavioural aspects;

At the Conference VI: "Building a healthy environment at school”, done by Professor Dr. Antonio Ricardo Catunda de Oliveira, the State University of Ceará, he addressed three key issues: the school and physical education; international consensus and the educational value of physical education.

On this track, it is clear that the Education and Physical Education have been changing over time, and the configuration of the current society. We recognize the benefits of physical activity for people's health, but we know that his practice has been decreasing over time. In today's context, what are the objectives of physical education in this context? Do we recognize that school is the only way most children can get physical activity instructions for them and their lives?

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focusing on the activities to be performed. Therefore, the scenario is favourable to Physical Education, configuring itself as an excellent opportunity to deal with this new challenge it is presented.

Challenges such as students’ low engagement in class, the state of lethargy into which Education is found nowadays, the poor utilization of the youngest characteristics, like the preference for activities which offer challenges and problem-solving strategies, the lack of materials and suitable spaces for the practice of physical education, unmotivated teachers and, exceptionally, the first generation with lower life expectancy than their parents. Faced with these highlights of IT IS RECOMMENDED:

✓ to maintain community partnerships, involve managers, teachers, family and take advantage of the available inter-sectoral public policies;

✓ to use active methods in class;

✓ to make the school a healthy environment, motivating, engaging and promoting the well-being;

✓ programs targeted to teachers for permanent and progressive qualification; ✓ the appreciation of teachers offering

better working conditions and salaries, the importance of their role in the school improvement;

✓ to promote motivation and commitment of the school community;

✓ to ensure physical education based on quality references at all educational levels;

✓ attention to Early Childhood Education mandating the presence of licensed teachers in Physical Education;

✓ to promote healthy habits through interdisciplinary projects for the practice of physical activities and healthy eating; ✓ to think about the school collectively,

with goals shared by everyone.

Motricidade

2017, vol. 13, S1, pp. 7-13 I CINAPSE 2016

1 _{State University of Ceará, Fortaleza, Brazil.}

* Corresponding Author: State University of Ceará, Dr. Silas Munguba Av., 1700, Campus do Itaperi, 60714-903,

Fortaleza – Ceará, Brazil. Email: jaina.bezerra@uece.br

Cardiovascular risk factors in adolescents: a study with high

school students

Jaina Bezerra de Aguiar

, Marcos Augusto Araújo Silveira

, Edson Silva Soares

, Adriano

César Carneiro Loureiro

ORIGINALARTICLE

ABSTRACT

The purpose of the study was to investigate cardiovascular risk factors (CRF) found in adolescents from a public school in Fortaleza / Ceará / Brazil. The sample consisted of 180 students from the State High School Justiniano de Serpa, which is covered by sub-project of the course of Physical Education of the Institutional Program Initiation Grant for Teaching from the State University of Ceará. For data collection, it was used a questionnaire which included objective questions related to gender, age, alcohol consumption, smoking, physical activity level, and family history. Besides that, a physical evaluation was conducted in which it was collected height, weight, and waist circumference. For data analysis, it was used the absolute and relative frequency to characterize the participants as well as chi-square test for the variables gender and level of physical activity. Results showed the percentage of overweight and obesity was 22.2% and 12.2%, respectively. Furthermore, 16.7% of adolescents had abdominal obesity, 6% reported alcohol consumption, and 1% smoking. In family history, highlighted the presence of diabetes, hypertension, and high cholesterol levels, which together amounted to 65.4%. The results also showed 79.4% of adolescents had insufficient levels of physical activity. It is concluded that the main CRF found were family history, physical activity, and overweight.

Keywords: cardiovascular diseases, school health, physical education and training.

INTRODUCTION

The sedentary lifestyle is a huge damage for society, becoming a determining factor for the great increase of cardiovascular diseases (CVD), as well as other chronic non-communicable diseases. Therefore, there is an incessant search for the population to become, more and more, physically active. Physical activity (PA), as well as physical exercise, is today considered synonym of quality of life (Mendonça, 2012).

Nowadays, a study showed that not only adults are affected by CVD, but also children and adolescents (Burgos et al, 2013). There has been a recent increase in the diagnosis of systemic arterial hypertension in young population. In addition, childhood obesity has been identified as an important risk factor in the development of CVD (Burgos et al, 2013).

This phenomenon is undoubtedly due to a significant decrease in PA, sedentary lifestyle, combined with poor diet and the new behavioural routine of the human being, which

has led to an increase in the incidence of various diseases related to this lifestyle, such as stress, anxiety, cancer, hypertension, diabetes, dyslipidaemias, obesity and, consequently, CVD (Mendes, Alves, Alves, Siqueira, & Freire, 2006).

In contrast, the practice of AF provides several benefits, such as increased self-esteem and well-being, stress relief, full functioning of the immune system, and others (World Health Organization [WHO], 2015). Moreover, it is a relevant protection factor against obesity, diabetes and CVD, some cancers and mental disorders, in other words, being impactful in health promotion and disease prevention (WHO, 2015).

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school context. Besides of contributing for the development of more attentive professionals, who assess the health status of the students as well as orienting / stimulating the changes of lifestyle, seeking in fact the adoption of a healthy lifestyle by the students.

The relevance of this study is to contribute for the teaching practice of the physical education professional through health education: alerting him about the social and epidemiological reality of high school students, aiming to improve the quality of life and health promotion, as well as providing clinical data of high school students and their relationship with a major Public Health problem, which are CVD.

Thus, it was intended to answer in the study the question: what are the CRF found in adolescents from a high school institution of the capital city of the state of Ceará? Therefore, the objective of this study was to investigate and analyse the CRF found in adolescents, from a public school in the city of Fortaleza/Ceará.

METHOD

The study was characterized by quantitative and qualitative field research, through a data collection under an objective character, in a closed questionnaire of opinion research and physical evaluation, both of which were cross-sectional.

Participants

This study was based on the database of a survey conducted in 2015 at the State Public High School Justiniano de Serpa, Fortaleza, Ceará, Brazil, which is covered by the subproject of the course of Physical Education of the Institutional Program Initiation Grant for Teaching (PIGT) of the State University of Ceará. The sample of the present research was constituted by 180 students, of both genders and who were present in the classes of physical education of the mentioned school. Only those students who were voluntarily interested in participating of the program and who were regularly enrolled in the school were included.

Instruments and Procedures

The physical evaluation collected data regarding to height and weight (Petroski protocol, 2011), and waist circumference (WC) (protocol of Callaway et al., 1991). The WC values allowed characterizing the amount of body fat located in the abdominal region (according to the critical values proposed by Taylor, Jones, Williams, & Goulding, 2000). For the identification of the nutritional profile of the sample, the body mass index (BMI) was calculated, given by the formula weight (kg) divided by the square of the height (m). The diagnosis of different nutritional status was investigated by BMI for age. The cut point used was provided by the World Health Organization (World Health Organization [WHO], 2006). The questionnaire had objective questions related to gender, age, alcohol consumption, smoking, physical activity level, and family history for CRF.

The participants were formally invited and during the study the objectives of the research and the ethical aspects involving human beings were explained. Data collection techniques and procedures were consultations to the physical evaluations and the questionnaires applied in the school, which occurred in the period from March to June of 2015. The physical evaluations happened in a classroom of the school. They were conducted by the scholarship holders of the program who were trained by one of the researcher professors. The questionnaires were completed by the participants at the same location as the physical assessment data collection.

For the use of the documentary data, the authorization of the coordination of the PIGT was requested through a declaration of faithful depositary, which allowed the use of data already collected.

Cardiovascular risk factors in adolescents |

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Statistical analysis

The questionnaire and the data collected were numbered and quantified. The data were analysed through descriptive statistics using SPSS software version 22.0, and presented in tables and graphs. The absolute and relative frequency was used to characterize the participants and Chi-Square test to observe the possible associations between the variables gender and level of physical activity, adopting as criterion of statistical significance p <0.05.

RESULTS

The sample was composed in its totality by adolescents, with age between 13 and 17 years and average age of 15.1 ± 0.73. In the Table 1, there is their sociodemographic and clinical-epidemiological characterization. The hereditary factor exerts a strong influence on the onset of CVD and other diseases (Walter et al., 2004). After analysing the data, the presence of some diseases that represent a risk to the cardiovascular system can be verified through the family history of adolescents (Graph 1). Only 12.2% of the students reported having no disease in the family history. O Graph II shows the distribution of the sample by gender, classification of the physical activity level, obtaining a high prevalence of adolescents with insufficient levels of physical activity (79.4%). Likewise, it is worth mentioning that the levels of physical activity below the recommended level are higher in female adolescents (53.3%) than in the male (16.1%). However, levels above the

recommended are higher in male adolescents (13.3%) than in female (7.2%).

By the chi-square test, we can report the difference between male and female adolescents is statistically significant (p <0.001). This shows that there is a relationship between gender and the level of physical activity. In other words, male adolescents have a more active lifestyle compared to females. By checking and analysing the different variables of the study, it was possible to generate a graph (Graph 3) with the prevalence of CRF. The variables described consider behavioural health habits and the possible inherited genetic load.

Table 1

Sociodemographic and clinical characterization of high school adolescents

Variables n %

Gender (n)

Male 71 39.4%

Female 109 60.6%

BMI

Eutrophic 118 65.6%

Overweight 40 22.2%

Obesity 22 12.2%

WC

Normal 150 83.3%

Risk 30 16.7%

Alcoholism

No 169 93.9%

Yes 11 6.1%

Smoking

Yes 1 0.6%

Have smoked 10 5.6%

No 169 93.9%

Graphic 1. Percentage distribution of the sample group by the prevalence of cardiovascular risk diseases in the

family history 0% 5% 10% 15% 20% 25%

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Graphic 2. Percentage distribution of the sample group by the prevalence of cardiovascular risk diseases in the

family history

Graphic 3. Prevalence of CRF in high school adolescents

DISCUSSION

The sample group of adolescents was evaluated to investigate the presence of CRF in these individuals, since there is a strong correlation between the existence and severity of CVD and the presence of their factors in the early stages of life (Quadros, Gordia, Silva, Silva, & Mota, 2016). In conjunction with other studies (Brito et al., 2016, Quadros et al., 2016), we also obtained a higher participation of female adolescents (60.6%). We believe that this fact is related to demographic issues that according to the Brazilian Institute of Geography and Statistics - IBGE (2010a) the female population is more numerous.

By characterized the adolescents through BMI, it was verified that the percentage of overweight and obesity is of 22.2% and 12.2%, respectively. This data corroborates with the findings of Ribas and Silva (2014), in which the number of adolescents with BMI classified as normal is prevalent when compared to the number with excess weight. However, this number of overweight adolescents is a concern,

since BMI in young population is considered a risk for possible coronary diseases in adult life.

It was also verified the WC, since it is known that the fat accumulated and located in the central region has contributed to the development of diseases (Pereira et al., 2010). Table 1 shows that 16.7% of adolescents in the sample had abdominal obesity. This value generates concern since several studies in children and adolescents have observed a significant association between WC and CRF (Bitsori, Linardakis, Tabakaki, & Kafatos, 2009; Pereira et al., 2010;). Other investigated risk factors, such as alcoholism (6%) and smoking (1%) presented a small number of cases, and similar results were found by Farias Júnior, Mendes, Barbosa, and Lopes (2011). Through these results it is possible to suggest that the populations studied seem to be aware of the harm that these habits cause to health and may be a result of health education campaigns and actions carried out in the last decades in Brazil.

It is possible to verify through the graph II, some DCVs related to the family history of the 0%

5% 10% 15% 20% 25% 30% 35%

S E D E N T A R Y L I F E S T Y L E

< 6 0 ' P E R D A Y > 6 0 ' P E R D A Y

%

MALE

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Family History Insuficient Physical Actvity Level

Overweight Abdominal Obesity

Cardiovascular risk factors in adolescents |

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sample group. Diabetes, hypertension, and dyslipidaemia, which together account for 65.4%, representing a high risk to cardiovascular health. Against this genetic tendency, verified through family history, adherence to and maintenance of healthy lifestyle is recommended - with adequacy of physical exercise; rich diet in fruits and vegetables; access to active leisure; no ingestion of alcoholic beverages; among other protective situations for cardiovascular risk (Gomes et al, 2012).

The results of the study showed a high presence of adolescents with insufficient levels of physical activity (79.4%), with a significantly higher prevalence in female adolescents (53.3% vs 16.1%), so the boys in the present study may be considered more active than the girls (Chart 2). However, their level of physical activity is still considered low, considering that only 13% reached the level of physical activity recommended by the WHO (2015). Insufficient practice of physical activity was also observed as a prevalent CRF in studies such as that of Quadros, Gordia, Silva, Silva, and Mota. (2016) and Farias Junior et al. (2011), being the insufficient practice present in 64.3% and 59.5% of the samples, respectively.

Thus, even physical activity is considered one of the most important actions to prevent the development of obesity and chronic diseases (Brito et al., 2016), it is a practice still little experienced in school life, especially in the female gender (Fermino et al. 2010). Among the main barriers reported for involvement in physical activity during childhood, there is a rise of passive leisure (television and video game) and decline of active leisure (jumping rope, elastic and cycling); in the period of adolescence, the environmental and socio-cultural factors are mentioned (Fermino et al., 2010; Santos, Hino, Reis, & Rodriguez-Añez, 2010).

It has been observed strong associations between the physical activity variables and cardiac risk, indicating an increase in risk as the level of physical activity reduces (Ekelund et al., 2012). The study of Gopinath, Hardy, Kifley, Baur and Mitchell (2014) reports that it is possible that the higher prevalence of high blood pressure among adolescents is related to longer

exposure to unhealthy behaviours, such as inadequate eating habits and insufficient activity practice physical. Accordingly, it is considered relevant to develop actions to promote physical activity in school to confront this CRF in the researched population (Quadros et al., 2016).

It was emphasized that the insufficient level of physical activity was the second most prevalent risk factor among all the factors studied in the present study, behind only the family history (Graph 3). This highlights the importance of interventions on the level of physical activity of children and adolescents.

Related to the presence of overweight, the present study found a higher prevalence (34%) than other national studies, such as Ribas and Silva (2014) (20.4%), Farias Junior et al. (2011) (10%) and 29.4% of Gomes et al. (2012). Despite the consequences, obesity is considered the fastest growing problem in the world. In Brazil, between 1974 and 2009, excess weight among adults almost tripled, culminating in 49% of overweight and 14.6% with obesity. The prevalence of overweight in children (47.8%) and adolescents (21.5%) was highlighted, which presented increases of three and four times, respectively, over the referred time frame (IBGE, 2010b).

Central obesity, due to WC measurement, was present in 17% of the analysed sample. This result is superior to the finding by Romanzini, Pelegrini, and Petroski (7%) and resembles that found by Gomes et al. 2012 (14.8%). In relation to gender, a higher proportion of girls (6.7%) with abdominal obesity were found in a sample of adolescents from the Northeast region when compared to boys (4.9%) (Cavalcanti et al., 2010). These evidences indicate an increase in abdominal obesity in adolescents, and knowing the factors associated with abdominal obesity are important to subsidize intervention programs in adolescents.

CONCLUSION

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However, it was verified through the study a prevalence of young students with insufficient levels of physical activity and with a relevant number of them with overweight and obesity. Therefore, it is important that public policies aimed at young population should orient and stimulate healthy habits of life, such as the importance of physical activity and healthy eating choices, contributing to the adhesion of a healthy lifestyle in this population.

It is suggested that studies be carried out to provide longitudinal follow-up with the young students, verifying and monitoring not only genetic and behavioural factors, but also environmental and psychological factors, so as make it possible to direct public intervention policies in the school environment.

Acknowledgments: Nothing to declare.

Conflict of interests: Nothing to declare.

Funding:

Nothing to declare.

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Motricidade

2017, vol. 13, S1, pp. 14-20 I CINAPSE 2016

1 _{Porto das Águas College (FAPAG), Porto Belo, Brazil.}

2 _{Avantis College, Balneário, Camboriú, Brazil.}

3 _{Municipal Secretary of Education, Itajaí, Brazil.}

* _{Corresponding Author: Porto das Águas College (FAPAG), Av. Vereador Abraão João Francisco, 3855, Sacada,}

88307-303, Itajaí, Brazil. Email: zilamflores@gmail.com

Evaluation of nutritional status of children aged 0 to 5 years old in

Early Childhood Education of the Municipal Education Network of

Itajaí/SC

Zilá Gomes de Moraes Flores

, Elisabete Laurindo de Souza

, Edegilson de Souza

ORIGINALARTICLE

ABSTRACT

The increasing number of children from 0 to 5 years old, evaluated as overweight in recent years, motivated teams of the Health Program at School and the School Feeding Program of the Municipal School Network of Itajaí/SC (Brazil) to conduct a research in order to verify the nutritional status of students regularly attending the Early Childhood Education centers. We seek to minimize the effects of this condition throughout life. We adopted the cross-sectional, descriptive and field study method, with data collection between April and July 2016, from 64 Early Childhood Education Centers. Data shows that 925 children, representing 1/3 of the total number of students aged 0 to 5 years and 11 months old, are in an overweight situation. From those, 610 were with high weight for the age, corroborating the waistline perimeter data (WP) with children at risk; 175 children were diagnosed with thinness and, of these, 65 also have low weight for their age. Thus, these children require special attention of those involved. We considered, therefore, the study presented extremely important as it may trigger prevention actions and immediate intervention.

Keywords: physical education, early childhood education, childhood obesity, nutrition evaluation.

INTRODUCTION

The World Health Organization (WHO) points out that the biggest public health problem in the world today is obesity, which is growing at a rapid pace. The Organization predicts that about 2.3 billion adults may be diagnosed with being overweight. This is even more worrying as the projection estimates that 700 million people might present an obese state and that the number of overweight and obese children in the world may reach 75 million if nothing is done about it (Brazil, 2014).

The reality in Brazil is also a concern due to the growth of obesity rates in the country. Some surveys indicate that more than 50% of the population is classified as being overweight and obese. Among children, this rate reaches approximately 15%, according to a study done by the National Network of Early Childhood (Rede Nacional da Primeira Infância - RNPI, 2014).

The growing interest in the search for reasons about the prevalence and factors

associated with the diagnosis of overweight and obesity in 0 to 5-year-old children has been verified in several studies. The main causes of being overweight are associated with improper eating habits, sedentary lifestyle, overweight and obese parents, socioeconomic status and environmental factors (Onis, 2015; Rivera et al., 2014).

Obesity is defined as an atypical accumulation or excess of fat in the body, which can lead to negative implications for the health condition and to the development of other

pathologies such as diabetes,

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According to RNPI (2014), in Latin America, approximately 3.8 million children aged up to five years old were diagnosed with excessive weight: overweight or obesity. At the same time, the same data was pointed out by the Pan American Health Organization (PAHO, 2014), in its report, which presents obesity as an epidemic. Data from the Food and Nutritional Surveillance System of the Ministry of Health (Brazil, 2014) has revealed a rise in the diagnosis of overweight risk, overweight and obesity in Brazilian children in recent years, increasing the epidemiological panorama of the so-called non-communicable diseases, which are risk factors for other diseases.

Although the data presented shows problems of excessive weight, the table of classification of nutritional status also presents diagnoses of thinness and acute thinness that occur throughout the country, especially in children living in conditions of social vulnerability. According to Conde and Gigante (2007), underweight or malnutrition has been considered, if not the main cause, one of the risk factors relevant to the number of people with disability and the fourth factor for mortality in terms of world population, especially in developing countries. In Brazil, according to IBGE (2006), underweight cases (below z-2.0 score) are among the poorest social classes, whose total family income is lower than the minimum wage. The highest frequency is in urban areas, in the North and Northeast regions. Chagas et al. (2013), in a survey in the six largest municipalities of the state of Maranhão (Brazil), in 2006/2007, with 1214 under five-year-old children, found that in the weight-for-age classification, malnutrition was 4.5%, and in the weight-for-height 3.9% were already classified as malnourished, corroborating with height-for-age of 8.5% of children with previous malnutrition; and 6.7% being overweight.

Lima et al. (2010), in a survey carried out in the northeast of Brazil, on the causes of the decline of malnutrition in that region, confirmed that the prevalence of malnutrition due to being underweight has decreased in Brazil. On the other hand, it has been noticed the prevalence of diagnoses related to overweight in children,

although it is not affirmed that there was a substitution or compensation, but that the interferences of environment, the increase of nutritional options and the possible decrease of children’s physical activity, can justify that the cases of overweight and obesity prevail to those of thinness.

Magalhães, Sant’Ana, Priore and Franceschini

(2014), in a bibliographical study, analyzed researches with indicators for fat accumulation, among them the Waist Perimeter (WP), stating that the WP measure, when assessing obesity in the abdominal region, revealed that fat excess in the central region of the trunk in children corroborates the results obtained in other indicators, such as the Body Mass Index (BMI).

In the Municipal School Network of the city of Itajai (Santa Catarina – Brazil), there are about 10 thousand students enrolled in Early Childhood Education, aged 0 to 5 years and 11 months old, distributed in nursery, pre-kindergarten, pre-kindergarten, pre-school, living daily in an educational environment that has the institutional role of caring for and educating young children at all times during their routine (Itajaí, 2015), namely: the entrance and exit, feeding, hygiene, rest, plays, Physical Education classes in the park and in the external areas, among other activities that are experienced daily by the children, being translated into meaningful experiences.

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Therefore, this research is justified because, nowadays, many children are at risk due to their body composition condition. According to WHO (2015), about 40% of Brazilian children are diagnosed with overweight and obesity, and, despite that, diagnoses of malnutrition due to being underweight still occurs.

This research was inserted in the Brazil Platform n.º CAAE: 55258116.3.0000.5592, and evaluated and approved by the Committee of Ethics and Research of the Avantis College under the protocol n.º 032069/2016.

METHOD

This is a cross-sectional, descriptive and field study (Thomas, Nelson, & Silverman, 2012). Data was collected between April and July 2016 in 64 Early Childhood Education Centers of Itajai/SC, which belong to the Municipal School Network, with students enrolled and present on the day of data collection. However, it is necessary to emphasize that the research samples did not consider as basis of analysis the students with Down Syndrome, because they are subjects that must be evaluated in a specific manner.

The nutritional diagnosis of the students was defined based on the widely used anthropometric indices indicated by the WHO (2006, 2007 as cited in Brazil, 2011), and adopted by the Brazilian Ministry of Health for the evaluation and classification of the nutritional status of children according to gender: BMI-for-age, weight-for-age, height-for-age for all, and weight-for-height for children up to 60 months of age; as well as Waist Perimeter (WP) classified by Fernández, Redden, Pietrobelli and Allison (2004) for children over 2 years old.

Participants

The sample size covered 6,432 children aged 0 to 5 years and 11 months old, corresponding to 66% of the total number of children enrolled in the 64 Early Childhood Education Centers of Itajaí/SC in the Municipal School Network. The age of the children was defined in months based on the difference between the date of birth reported by the schools and the date when data

was collected. Anonymity and confidentiality were guaranteed to the subjects.

Instruments and Procedures

The instrumentation adopted for data collection included the elaboration of spreadsheets with the students’ cadastral information, containing: class, name, date of birth and gender; Mabbis® non-elastic, flexible anthropometric tape; Welmy® baby scale and WCS® horizontal anthropometer to verify the length; Powner® digital scale, with a maximum capacity of 150 kg; WCS® stadiometer, built in wood, with printed scale, varying from 40 to 220 cm. Following the guidelines for the collection of anthropometric measurements from the Ministry of Health (Brazil, 2011), the weight was measured and recorded in kilograms on the scale for babies, weighed without clothing; the other children were weighed on a digital scale placed on a flat even floor, assuming the orthostatic positioning, barefoot, without coats, upper limbs along the body, head with the Frankfurt plan established. The length was measured in children up to 2 years of age with the anthropometer, in the oldest the height was measured also observing the orthostatic positioning, barefoot, the head with the Frankfurt plan established, registered in the nearest millimeter.

The anthropometric evaluation of the students was established from the calculation of the Body Mass Index, verified through the formula:

𝐵𝑀𝐼 = weight height2

Nutritional status in Early Childhood Education |

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Surveillance System’ of SISVAN - Ministry of Health (Brazil, 2011).

For the classification of the cardiac risk of the students, the Perimeter of the Waist (PW) according to Petroski’s protocol (2007) was measured, being verified with the anthropometric tape and having as reference the midpoint between the last lower rib and the iliac crest. The data obtained were registered to the nearest millimeter, classified by the percentile tables for PW of Fernández et al. (2004), for children and adolescents from 2 to 18 years of age, by gender, considering the cut-off points for Risk and No Risk.

The researchers decided to add the classification ‘Near Risk’, for children who, despite not being at risk, present proximity of values of risk classification, serving as an alert.

Statistical analysis

Data was tabulated in the Microsoft Excel® program and are expressed in percentages, considering that the research is still in progress for the data collection with children and adolescents of Elementary and Young Adult Education (called EJA in Brazil).

The statistical results of the research by categories according to the anthropometric indices evaluated are presented in tables. No statistical association was made considering the gender of the students with the other data investigated.

RESULTS

The results of the anthropometric indices, divided by categories, are presented in Tables 1 to 5.

Table 1

Classification of weight-for-age data obtained according to WHO tables (2006/2007 as cited in Brazil, 2011)

Categories Frequence/Students Percentual

Very low weight for age 19 0.30%

Low weight for age 46 0.72%

Appropriate weight for age 5757 89.51%

High weight for age 610 9.48%

Total 6432 100.00%

Table 2

Classification of height-for-age data obtained from WHO tables (2006/2007 as cited in Brazil, 2011)

Categories Frequence/Students Percentual

Very short height for age 36 0.56%

Short height for age 160 2.49%

Adequate height for age 6236 96.95%

Total 6432 100.00%

Table 3

Classification of BMI-for-age data obtained according to the WHO tables (2006/2007 as cited in Brazil, 2011)

Categories Frequence/Students Percentual

Healthy 4013 62.39%

Risk of overweight 1317 20.48%

Overweight 622 9.67%

Obesity 249 3.87%

Severe obesity 56 0.87%

Thinness 121 1.88%

Acute thinness 54 0.84%

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Table 4

Classification of weight-for-height data obtained according to WHO tables (2006/2007 as cited in Brazil, 2011), for children up to 60 months old

Categories Frequence/Students Percentual

Healthy 3336 63.41%

Risk of overweight 1255 23.85%

Overweight 407 7.74%

Obesity 146 2.78%

Thinness 76 1.44%

Acute thinness 41 0.78%

Total 5261 100.00%

Table 5

Classification of waist perimeter data obtained according to Fernández et al. (2004) for children above 2 years old

Categories Frequence/Students Percentual

Without risk 3558 68.33%

Close to risk 299 5.74%

Risk 1350 25.93%

Total 5207 100.00%

DISCUSSION

From the data presented, we can verify that the prevalence of malnutrition is low in relation to the values of overweight indicators. Although society discusses obesity as an epidemic, this is worrying as malnutrition and its consequences are forgotten.

Chagas et al. (2013) investigated children from six municipalities in the state of Maranhão (Brazil). They found 4.5% of those evaluated with BMI rating of thinness, and the values of the weight index for the stature of 3.9% in malnutrition at that time. These are values that differ from the 2.0% thinness found in Itajaí/SC, indicating malnutrition for both BMI and weight-for-height, which could trigger diseases such as anemia and hypovitaminosis, exposing the subjects to a high risk of becoming ill and even dying.

The overweight indicators of both BMI and weight-for-height were 34.89% and 34.37%, respectively. Comparing them to the data obtained by the analysis and classification of the WP, 25.93% are at risk; and 5.74% with values very close to the risk percentiles, which totals 31.67% of children over 2 years old. Therefore, through the approximation of results, the confirmation of these values indicates risks for

children to become obese adults, develop noncommunicable diseases linked to obesity, such as diabetes, hypertension, high cholesterol, insulin resistance, and triglycerides, among others (Onis, 2015).

In the study of Vitolo et al. (2008), of 3,957 children aged 1 month to 5 years old, during the National Vaccination Campaign in the city of São Leopoldo (Rio Grande do Sul – Brazil) in 2002, they found that 9.8% of the evaluated children were overweight.

The data presented by Miglioli et al. (2015), in a cross-sectional study investigating the nutritional status of 790 children under five years of age, they found 1.5% of those evaluated through BMI for age with low-weight diagnosis; and through the weight-for-age classification 2.6% were with underweight diagnosis. With the same indicators, 4.7% and 8.6% of the children diagnosed, respectively, with overweight, and 8.9% of the sample with short height-for-age, differing from the data found in this research of 3%, when the data of short stature and very short stature were added.

In this aspect, we can see that, although the sample is smaller, the data presented by Vitolo, Gama, Bortolini, Campagnolo, and Drachler (2008) and Miglioli et al. (2015) are also generally close to the data of the research with the children of Itajaí/SC, in which the BMI indices by age and height-for-age are very close in all their classifications.

In the study carried out in Itajaí/SC, we can verify a higher percentage of children who have high weight compared to that found by Schuch, Castro, Vasconcelos, Dutra, and Goldani (2013). The authors carried out a study with students from public schools in the states of Rio Grande do Sul and Santa Catarina, totaling 4,914 children (2,578 in Rio Grande do Sul and 2,336 in Santa Catarina). In the case of Santa Catarina, in six municipalities, 7.5% of the children were overweight.

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that allows the consumption of a nutritious diet and physical activity exercise, and approaching the WHO global tactic on food intake, physical activity and health.

In relation to prevention, the Municipal School Network of Itajaí/SC, through the Municipal Department of Education, included Physical Education (PE) as a compulsory school content, taught by a PE professional in all Early Childhood Education schools in 2014.

It is worth clarifying that in all the years of elementary education, PE has already been an effective curricular component, taught by duly qualified teachers. The practice of physical and playful activity systematized since childhood can contribute to improving the health status of children. Concomitant with the inclusion of PE in Early Childhood Education, a Municipal School Feeding Plan was developed, which established rules and guidelines for local actions, including the substitution of rich in fat and sugar foods for natural ones. The consumption and variety of fruits and vegetables was considerably increased, as well as the inclusion of infant formula instead of cow’s milk for children up to 2 years of age, improving the nutritional quality of the menus served to children daily.

The intention of the Municipal Department of Education was to provide students with a healthy, balanced and adequate menu by age group, consisting of some whole foods such as bread, pasta and rice, beans, lentils, eggs, meat, fish, vegetables, varied fruits and natural juices. Another important measure was the deactivation of canteens in all school units in the municipality. The lack of anthropometric data prior to this action was a limiting factor for a comparative analysis to verify if the PE classes, as well as the adequacy of the menus, contributed or not to reduce the cases of overweight.

Another situation considered as limiting to this study refers to the impossibility of covering all the students in the data collection, although it is sensible to say that the sample of 66% is consistent to demonstrate its relevance. Data shows that 925 (1/3) children are in an overweight situation. Among these 610 have

high weight for their age, corroborating with Waist Perimeter (WP) data with children at risk, and 175 children with a diagnosis of thinness – among them, 65 also indicate low weight for age and need special attention.

CONCLUSION

In this study, the high number of overweight children found warn to the development of effective public policies. It is necessary to immediately implement a periodic evaluation routine for all children, since the early childhood education, involving Physical Education professionals, with training in protocols of anthropometric measures and adequate equipment.

The research developed, and the referenced studies show that the disposition for childhood obesity starts at six months. Thus, monitoring the growth pattern becomes effective to monitor and control the occurrence of overweight cases in school-age children and adolescents. This will enable immediate intervention throughout the observation of the increase in the percentiles of the BMI-for-age, weight-for-age, height-for-age, weight-for-height indicators and WP, providing to family members, schools, nutritionists and health-care professionals at school with up-to-date data and information, generating knowledge that supports the adoption of healthy eating habits and practices of physical activities in their daily routine. Thereby, ensuring the maintenance, preservation and expansion of times and spaces for physical activity at school are essential for the transformation of obesogenic environments into healthy environments.

Acknowledgments: Nothing to declare.

Conflict of interests: Nothing to declare.

Funding: